As veterans suicide rate continues to climb, survey requested by Murray shows that 40% of VA respondents say they can’t schedule mental health appointments for veterans in required time; 70% say they don’t have adequate staff or space to meet the mental health care needs of the veterans they serve

(Washington, D.C.) – U.S. Senator Patty Murray, Chairman of the Senate Veterans’ Affairs Committee, has sent a letter to the top health official at the Department of Veterans Affairs calling for improvements in mental health care delivery after a survey conducted by the VA at her request showed that many VA mental health care providers across the country don’t feel they have the resources needed to provide timely mental health care to veterans. The survey*, prepared at a time when 18 veterans a day are taking their own lives, shows that of the VA providers surveyed, nearly 40 percent said they cannot schedule an appointment in their own clinic within the VA mandated 14 day window, 70 percent said they did not have adequate staff or space to meet the mental health care needs of the veterans they serve, and 46 percent said the lack of off-hour appointments prevented veterans from accessing care. 

“The sad truth is that veterans who call to get a VA appointment have at least made the decision to reach out to VA for help,” Murray wrote. “That is the critical step in accessing care, and it is not acceptable to have veterans, who have stepped up and shown the courage to ask for help, be denied that care.”

Senator Murray requested the survey during a hearing of her Senate Committee on Veterans’ Affairs this summer that examined gaps in the VA’s mental health service efforts. At that hearing, Daniel Williams, a veteran, and Andrea Sawyer, a caregiver for her husband Loyd Sawyer, testified that they waited months to get follow-up appointments.

The full text of Senator Murray’s letter is below:

October 3, 2011

The Honorable Robert A. Petzel, MD
Under Secretary for Health
Department of Veterans Affairs
810 Vermont Avenue NW
Washington, DC 20420

Dear Dr. Petzel:

Under your leadership, the Department of Veterans Affairs (VA) has made strides in improving mental health care for veterans.  In addition to implementing the Veterans’ Mental Health and Other Care Improvements Act of 2008, VA has written state-of-the-art policies, begun integrating mental health in primary care, and created groundbreaking new programs, such as the suicide hotline.  VA has improved staffing guidelines, created new outreach programs and anti-stigma efforts, and required extended hours at some of its mental health clinics. The Department also continues to seek improvements, such as the ongoing effort to create joint clinical practice guidelines for the provision of mental health care from both VA and the Department of Defense.

However, much more remains to be done.  At a Senate Committee on Veterans’ Affairs hearing this summer reviewing the Department’s mental health services, Daniel Williams, a veteran, and Andrea Sawyer, a caregiver for her husband Loyd Sawyer, testified that they waited months to get follow-up appointments.  They are not the only ones, however.  Data provided by the Department on wait times for mental health appointments show unacceptably long delays in accessing care.  For example, at the Spokane medical center in my home state of Washington, the average wait time for a psychiatry appointment is almost 21 days, with barely more than half of such appointments meeting the 14 day standard, or at the Walla Walla clinic where less than half of mental health appointments are made according to the standard.

Almost three years after VA adopted the Uniform Mental Health Services Handbook, I continue to hear from veterans, their caregivers and health care providers that it has not been fully implemented.  To understand the disconnect between VA policy and practice,  I asked the Department to survey its mental health care providers across the country.  VA asked them what they thought about access, and the results were very troubling.

VA received responses from 272 mental health providers within five Veterans Integrated Service Networks.  Of these providers, nearly 40 percent said they cannot schedule an appointment in their own clinic for a new patient within 14 days.  Seventy percent said they did not have adequate staff or space to meet the mental health care needs of the veterans they serve, and 46 percent said the lack of off-hour appointments prevented veterans from accessing care.  In addition, over 26 percent of VA mental health providers said the need to perform compensation and pension examinations pulled them away from patient care. 

More troubling, however, is the apparent lack of a plan of action to address the issues these data illustrate.  Particularly in the Department’s written submission, the action items listed are almost entirely devoid of specific concrete steps which will be taken.  I am pleased that the Department is moving to a more robust and comprehensive measure of access to mental health care and will make this metric a component of VISN directors’ performance contracts, though I question why this was not done earlier.  I remain very concerned that the Department is going to delay other action for more than a year in order to conduct focus groups.  While I understand the Department has concerns that this survey is not comprehensive, after the countless Inspector General reports, GAO reports, hearings, public laws, conferences, and stories from veterans and clinicians in the field, it is time to act.

The sad truth is that veterans who call to get a VA appointment have at least made the decision to reach out to VA for help.  That is the critical step in accessing care, and it is not acceptable to have veterans, who have stepped up and shown the courage to ask for help, be denied that care.  Additionally, there are many veterans who, because of their mental illness, are unwilling or unable to navigate the VA system to get the help they need.  Many who have Post Traumatic Stress Disorder may develop severe symptoms a year or more after they return home.  VA must find a way to reach out to those veterans, and not wait for them to contact VA.

Dr. Petzel, I know that you and your leadership team are working hard to improve the delivery of health care to veterans, but the results of this survey and the mental health wait times data demonstrate there is much more that needs to be done.  I would like to know if you feel the Department has everything it needs, including sufficient resources and appropriate statutory authorities, to make the needed improvements.

Thank you for all you are doing and I look forward to working with you to support our nation’s veterans.

       Sincerely,        

       Patty Murray
       Chairman

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